International Orthopaedics

, Volume 34, Issue 6, pp 789–792

Total hip replacement as primary treatment of unstable intertrochanteric fractures in elderly patients

  • Amarjit Singh Sidhu
  • Ajay Pal Singh
  • Arun Pal Singh
  • Sukhraj Singh
Original Paper

Abstract

Fifty-three patients with A2.2 and A2.3 intertrochanteric fracture according to the Muller classification were treated with total hip replacement between April 2000 and February 2004. The average age of the patients was 77 years. Average follow-up period was 3.7 years. We studied postoperative complications, mortality rate, functional outcome using the Harris hip score, time to return to normal activities, and radiographic evidence of healing. Two patients died on the third and fifth postoperative days. Seven more patients died within one year. The Harris hip score at one month was 66 ± 7 (mean ± standard deviation); at three months 72 ± 6; at one year 74 ± 5; at three years 76 ± 6 and in the 27 patients who completed five year follow-up it was 76 ± 8. Mobilisation and weight-bearing was started immediately in the postoperative period. Average time taken to return to normal daily activities was 28 days (range 24–33). No loosening or infection of the implants was observed. Total hip arthroplasty is a valid treatment option for mobile and mentally healthy elderly patients with intertrochanteric fractures. This procedure offers quick recovery with little risk of mechanical failure, avoids the risks associated with internal fixation and enables the patient to maintain a good level of function immediately after surgery.

References

  1. 1.
    White BL, Fisher WD, Laurin CA (1987) Rate of mortality for elderly patients after fracture of the hip in the 1980’s. J Bone Joint Surg 69-A:1335–1340Google Scholar
  2. 2.
    Said GS, Farouk O, El-Sayed A, Said HG (2006) Salvage of failed dynamic hip screw fixation of intertrochanteric fractures. Injury 37:194–202CrossRefPubMedGoogle Scholar
  3. 3.
    Haentjens P, Casteleyn PP, Opedecam P (1994) Hip arthroplasty for failed internal fixation of intertrochanteric and subtrochanteric fractures in the elderly patient. Arch Orthop Trauma Surg 113(4):222–227CrossRefPubMedGoogle Scholar
  4. 4.
    Davis TR, Sher JL, Horsman A, Simpson M, Porter BB, Checketts RG (1990) Intertrochanteric femoral fractures. Mechanical failure after internal fixation. J Bone Joint Surg Br 72:26–31PubMedGoogle Scholar
  5. 5.
    Kim WY, Han CH, Park JI, Kim JY (2001) Failure of intertrochanteric fracture fixation with a dynamic hip screw in relation to pre-operative fracture stability and osteoporosis. Int Orthop 25(6):360–362CrossRefPubMedGoogle Scholar
  6. 6.
    Baumgaertner MR, Curtin SL, Lindskog DM (1998) Intramedullary versus extramedullary fixation for the treatment of intertrochanteric hip fractures. Clin Orthop 348:87–94PubMedGoogle Scholar
  7. 7.
    Brostrom LA, Barrios C, Kronberg M, Stark A, Walheim G (1992) Clinical features and walking ability in the early postoperative period after treatment of trochanteric hip fractures. Results with special reference to fracture type and surgical treatment. Ann Chir Gynaecol 81:66–71PubMedGoogle Scholar
  8. 8.
    Faldini C, Grandi G, Romagnoli M, Pagkrati S, Digennaro V, Faldini O, Giannini S (2006) Surgical treatment of unstable intertrochanteric fractures by bipolar hip replacement or total hip replacement in elderly osteoporotic patients. J Orthop Traumatol 7(3):117–121CrossRefGoogle Scholar
  9. 9.
    Tronzo RG (1974) The use of an endoprosthesis for severely comminuted trochanteric fractures. Orthop Clin North Am 5(4):679–681PubMedGoogle Scholar
  10. 10.
    Stern MB, Goldstein T (1979) Primary treatment of comminuted intertrochanteric fractures of the hip with a Leinbach prosthesis. Int Orthop 3(1):67–70CrossRefPubMedGoogle Scholar
  11. 11.
    Haentjens P, Casteleyn PP, De Boeck H, Handleberg F, Opedcam P (1989) Treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Primary bipolar arthroplasty compared with internal fixation. J Bone Joint Surg Am 71:1214–1225PubMedGoogle Scholar
  12. 12.
    Haentjens P, Casteleyn PP, Opdecam P (1989) Primary bipolar arthroplasty or total hip arthroplasty for the treatment of unstable intertrochanteric and subtrochanteric fractures in elderly patients. Acta Orthop Belg 60(Suppl 1):124–128Google Scholar
  13. 13.
    Vahl AC, Jacobs PBD, Patka P, Haarman HJ (1994) Hemiarthroplasty in elderly, debilitated patients with an unstable femoral fracture in the trochanteric region. Acta Orthopedica Belgica 60:274–278Google Scholar
  14. 14.
    Rodop O, Kiral A, Kaplan H, Akmaz I (2002) Primary bipolar hemiprosthesis for unstable intertrochanteric fractures. Int Orthop 26:233–237CrossRefPubMedGoogle Scholar
  15. 15.
    Stern MB, Angerman A (1987) Comminuted intertrochanteric fractures treated with a Leinbach prosthesis. Clin Orthop 218:75–80PubMedGoogle Scholar
  16. 16.
    Zuckerman JD (1996) Hip fractures. N Engl J Med 334:1519–1525CrossRefPubMedGoogle Scholar
  17. 17.
    Grimsrud C, Monzon RJ, Richman J, Ries MD (2005) Cemented hip arthroplasty with a novel circlage technique for unstable intertrochanteric hip fractures. J Arthroplasty 20:337–343CrossRefPubMedGoogle Scholar
  18. 18.
    Aprin H, Kilfoyle RM (1980) Treatment of trochanteric fractures with Ender rods. J Trauma 20(1):32–42PubMedGoogle Scholar
  19. 19.
    Keating JF, Grant A, Masson A, Scott NW, Forbes JF (2006) Randomised comparison of reduction and fixation, bipolar hemiarthroplasty and total hip replacement: treatment of displaced intracapsular hip fracture in healthy older patients. J Bone Joint Surg Br 88:149–260CrossRefGoogle Scholar
  20. 20.
    Dalldorf PG, Banas MP, Hicks DG, Pellegrini VD (1995) Rate of degeneration of human acetabular cartilage after hemiarthroplasty. J Bone Joint Surg Am 77:877–882PubMedGoogle Scholar
  21. 21.
    Takaoka K, Nishina T, Ohzono K, Saito M, Matsui M, Sugano N et al (1992) Bipolar prosthetic replacement for the treatment of avascular necrosis of the femoral head. Clin Orthop 277:121–127PubMedGoogle Scholar
  22. 22.
    Lester DK, Wertenbruch JM, Piatkowski AM (1999) Degenerative changes in normal femoral heads in the elderly. J Arthroplasty 14:200–203CrossRefPubMedGoogle Scholar
  23. 23.
    Ravikumar KJ, Marsh G (2000) Internal fixation versus hemiarthroplasty versus total hip arthroplasty for displaced subcapital fractures of femur-13 year results of a prospective randomized study. Injury 31(10):793–797CrossRefPubMedGoogle Scholar
  24. 24.
    Gebhard JS, Amstutz HC, Zinar DM, Dorey FJ (1992) A comparison of total hip arthroplasty and hemiarthroplasty for treatment of acute fracture of the femoral neck. Clin Orthop Relat Res 282:123–131PubMedGoogle Scholar
  25. 25.
    Haentjens P, Lamraski G (2005) Endoprosthetic replacement of unstable, comminuted intertrochanteric fracture of the femur in the elderly, osteoporotic patient. Disabil Rehabil 27(18–19):1167–1180CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Amarjit Singh Sidhu
    • 1
  • Ajay Pal Singh
    • 2
    • 3
  • Arun Pal Singh
    • 3
  • Sukhraj Singh
    • 1
  1. 1.Department of OrthopaedicsGovt Medical College & Rajindra Hospital PatialaPunjabIndia
  2. 2.D-13, Residential ComplexUniversity College of Medical Sciences & GTB HospitalNew DelhiIndia
  3. 3.Department of OrthopaedicsUniversity College of Medical Sciences & GTB HospitalNew DelhiIndia

Personalised recommendations